If you are dental professional from a clinic performing this on behalf of a patient, and prefer to send an electronic application that you have generated from your clinic’s software, click here instead.
Fill out the form below including a co-applicant if required. Once you have filled out the form you will be contacted by one of our agents with the results of your application. All fields with an astrix* are mandatory.
If you prefer to apply by phone, please click here and ask for someone to call you.
If you prefer to apply by fax, please click here and download the denture financing application form.* Denture Financing is currently only available for Canadian residents.